• Kentucky Authorization to Conduct Criminal Records Check, Driving History Records Check, and Credit Reports Check

    (Please Read Carefully Before Completing and Signing)

  • The items of personal information requested below are needed to process your background investigation. This information is intended solely for that purpose and shall not be used in a discriminatory manner by the parties noted below in the making of appropriate business decisions.


    Printed full name of applicant and current address:

  • Date of Birth (m/d/y)*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Have you ever been convicted of a crime (Omit minor traffic offenses)?*
  • Have you ever engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility or other institution (as defined in 42 U.S.C. 1997)?*
  • Have you been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force or coercion or if the victim did not consent or was unable to consent or refuse?*
  • Have you been civilly or administratively adjudicated to have engaged in the activity described in the previous question?*
  • Have you been involved in any incidents of sexual harassment?*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  •  
  • Should be Empty: